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Medic-All Headache Team, Taipei VGH 〉 Neuromodualation for intractable migraine

Neuromodualation for intractable migraine

Neuromodualation for intractable migraine

1. Occipital nerve stimulation (ONS)
2. Repetitive transcranial magnetic stimulation (rTMS)

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Overview
Chronic migraine is a highly prevalent and disabling disease. The drugs prescribed for migraine prophylaxis can have intolerable side effects or can be ineffective. Neuromodulation techniques are increasingly used in neurology. Among these techniques, we provide invasive occipital nerve stimulation and rTMS to treat patients with medically intractable migraine, and the results are encouraging. Most importantly, these neuromodulation therapies appear safe with a low rate of side effects. In the future, neuromodulation will probably take an increasing place in migraine treatment, as add-on therapy or alternative to medications, especially because of its attractive safety profile.
Features
  1. In an open label trial of our group (published in J Chinese Med Ass 2016), 4-week rTMS with continuous theta burst stimulation on the primary motor cortex can significant reduced the headache frequency from 13.4 ± 10.1 days at baseline to 9.4 ± 6.2 days ( p=0.024) during treatment and 8.7 ± 10.1 days (p=0.012) at follow-up 4 weeks after treatment. There was no significant treatment-related adverse events in all the 9 patients enrolled in this study.
  2. We have 4 patients underwent invasive occipital nerve stimulation and three of them had a headache frequency reduction over 50% both at discharge and at 1-month follow-up (unpublished data). One patient had lead displacement after discharge and was removed two weeks later.
Service Procedure
1. ONS:
Every patients will undergo a detailed consulatation with neurologists, neurosurgeons and the nursing staff at admission. After placement of a test lead, we will evaluate the safety and efficacy of occipital nerve stimulation for 2 weeks. A permanent lead implantation will be arranged if the test lead works well without significant adverse events.

2. rTMS:
Before treatment of rTMS, all patients will be consulted to ensure they understand the detailed procedure and safety of this neurodulation technique. The patient just need to sit comfortably in a quite room to complete each treatment session (~ 30-60 min), and a treatment course typically takes 2-4 weeks. The patients will be asked to keep a diary during treatment.  
Notification
  1. ONS is an invasive procedure and risk of anesthesia is present. Despite the risk of anesthesia, lead disposition is the most common adverse events which can be corrected by lead replacement.
  2. rTMS is not invasive, but headache may occur during magnetic stimulation.
Estimated Cost
(Prices listed below are for reference. Actual cost may be according to the real expense during the hospitalization.)
~15000-20000 USD
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